Child Care: Common Problems in Newborn Children

1. Small Boils on the skin

They are broken by firmly rubbing them with a cotton swab soaked in gentian violet paint, which subsequently is applied over the raw areas till healing is there. As long as the baby is active and sucking well, there is no need for oral antibiotics or other medications.

2. Thrush

It is a fungal infection of the tongue seen mainly in bottle fed babies or those who are on antibiotics. It appears like a white coating on the tongue, which can be confused with a milk layer. The milk layer however, disappears if the tongue is cleaned. Thrush is common but benign. A 5-day local application over the tongue of an anti-fungal lotion cures it.

3. Jaundice

Most of the babies have a “physiological” jaundice for which no therapy is required. Some babies, however, may have jaundice which is more than normal (e.g. for term babies, the upper limit is 17 mg%. If the bilirubin is more than 17 mg%, the jaundice is not physiological and requires treatment). Putting the baby under light, called “phototherapy” is the treatment given to such babies. Rarely, jaundice may become severe enough to threaten damage to the baby’s brain, in which case “exchange transfusion” is done. In this whole of the baby’s blood is exchanged with an equal amount of adult blood.

Mothers of the “negative” blood group may have babies with severe jaundice if the baby’s blood group is “positive”. Usually, the first baby escapes and it is the 2nd baby onwards that is afflicted by severe jaundice. Excellent prevention against this is fortunately, available. It consists of giving “negative” mothers an injection of “Anti-D” during 24-28 weeks of pregnancy and again within 72 hours after delivery whenever they give birth to a “positive” baby. This prevents subsequent babies from developing severe jaundice.

4. Eye discharge

Many babies have discharge from their eyes. If the discharge is cloudy, pus like, with redness of the eyes, it is due to an infection of the eye called “conjunctivitis.” It requires instillation of antibiotic eye drops. Often, a course of oral antibiotics is also required.

Commoner than this, however, is a condition in which the baby has a clear, watery discharge from the eyes without any redness. The eyes may appear sticky in the morning after sleep. This is a non-infective condition and is due to blockage of a thin tube called the nasolacrimal duct situated at the nose end of the eye, which drains the tears of the baby into the nose. When it gets blocked, the tears instead of going into the nose flow out of the eyes onto the cheeks. Many doctors recommend massaging the nose (near the eye). In most of the cases, the tube spontaneously opens by the end of 1-2 years; and so it is worth while for the parents to be patient and wait. If at the end of this period, the condition still persists, show your child to an eye specialist.

5. Navel problems

A slight discharge, whitish or yellowish in colour may come from the navel after the cord stump has fallen off. This is normal, usually lasts for a day or two and then stops. However, if the discharge is pus like or foul smelling, consult your doctor as it may signify an infection of the navel that may lead to dangerous complications. A slight amount of redness around the cord area is also normal.

Sometimes, there may be bleeding from the navel. If the blood is coming out because some clot or covering over the cord has been accidentally stripped off (e.g. during bathing or changing diapers), then there is no cause for alarm as the bleeding will usually stop by itself in 2-3 minutes. However, if there is spontaneous bleeding from the cord or the bleeding doesn’t stop, then consult your doctor immediately.

In some babies, there is a swelling at the navel area, which is soft and compressible. This swelling can be made smaller and to subside into the abdomen by compressing it. However, it will reappear. Called “Umbilical Hernia,” this doesn’t require any treatment as the swelling in most cases disappears permanently, as the child grows older. However, if the swelling is still present at the age of 4 years and above, show it to your doctor.

6. Blocked nose

It may be quite troublesome. The best treatment is to put normal saline drops in the nose and then clean the mucus in the nose by means of a cotton bud. Alternatively baby buds can be soaked in saline water and then gently inserted into the nose. After that the bud can be gently twirled in the nose and withdrawn. Any mucus that is present in the nose can thus be taken out along with the bud. Medicated drops (as opposed to normal saline drops) should be put only for 3-5 days at the maximum and that too under medical supervision.

Sometimes steroid nose drops may be required, particularly if the nose block is troublesome and not responding to the above treatments.

Oral decongestant drops may also be tried on the doctor’s advice.

Putting oil or milk in nose, putting milk in eyes: It is often seen that mothers put oil in the nose as a means of relieving the nose block, a common complaint amongst newborns. It is dangerous as the oil having a low viscosity may trickle down into the throat and thence into the lungs. Chronic use of oil in the nose has resulted in damage to the lungs and difficulty in breathing. Oil should not be put in the nose. The best thing is to put normal saline in the nose. Similarly putting breast milk in the eyes can result in undesirable side effects for the eye and is mentioned here to be discouraged.

7. Fever

As opposed to fever in an older child, any fever in a newborn baby or the opposite, i.e. the baby appears cold and lethargic, should be shown to a doctor on an urgent basis.

8. Diarrhea

If the baby is active, sucking well and the loose stools do not contain any pus or blood; there is no cause for alarm. Most of such diarrhea are self-limiting and don’t require any medicines. If the mother is breast-feeding and is taking some medicines like antibiotics or laxatives, the baby can have diarrhea due to that. In such a case it is advisable to stop or substitute the medicines that the mother is taking. Rarely, eating lots of onions, tomatoes, cabbages, chillies etc. by the breast-feeding mother can cause diarrhea in the baby.

A golden dictum is that breastfed babies usually don’t have infective diarrhea. So unless there is a compelling reason, a breast-fed baby having loose stools should not be prescribed any antibiotics, as the diarrhea is usually noninfectious. Diarrhea in a neonate may be harmless as mentioned above or a symptom of serious underlying disorders like sepsis. So if the baby doesn’t look well, is apathetic and doesn’t suck with the same vigor as before, immediately consult your doctor.

9. Upper limbs moving less

This is a complication of a difficult delivery, e.g. the baby is not coming out and so the doctor has to pull and manipulate the baby to make it deliver or apply forceps to pull out the baby. The above procedures adopted by the doctor to bring out the baby are medically fully justified. Rarely, as a result of this, there may be an injury to the bones of the upper limb (e.g. a break of the collarbone) or there may be an injury to the nerves supplying the upper limb (called “Erb’s Paralysis”). Fortunately, in both types of injuries, i.e. to the bones or the nerves, the baby recovers well and usually doesn’t have any residual problems.

In case of a bone injury, the upper limb may be splinted for 1-2 weeks. In case of a nerve injury, it takes about 2-3 months for the injured nerves to recover. During this time, no particular therapy or positioning of the limbs is required. Making the’ limb immobile (as in the case of bone injuries) is not recommended. The parents, after a week or so, should start physiotherapy of the upper limb, by actively moving the joints of the upper limb so that the muscles of the arm don’t go in a state of contracture.

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